Provider Demographics
NPI:1942934856
Name:FAITH PRIMARY CARE PLUS
Entity Type:Organization
Organization Name:FAITH PRIMARY CARE PLUS
Other - Org Name:FAITH PRIMARY CARE RURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGONDA'YEBENIT
Authorized Official - Middle Name:NZELLE
Authorized Official - Last Name:NGO MAYEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-536-2272
Mailing Address - Street 1:431 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2949
Mailing Address - Country:US
Mailing Address - Phone:910-557-5672
Mailing Address - Fax:910-557-5675
Practice Address - Street 1:431 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2949
Practice Address - Country:US
Practice Address - Phone:910-557-5672
Practice Address - Fax:910-557-5675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH PRIMARY CARE PLUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-15
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health